Provider Demographics
NPI:1194957803
Name:S. CHARLES KHANI, M.D. PHD, P.C.
Entity type:Organization
Organization Name:S. CHARLES KHANI, M.D. PHD, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHROKH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-922-1344
Mailing Address - Street 1:47 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1032
Mailing Address - Country:US
Mailing Address - Phone:978-922-1344
Mailing Address - Fax:978-922-1346
Practice Address - Street 1:900 CUMMINGS CTR
Practice Address - Street 2:SUITE 308V
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6198
Practice Address - Country:US
Practice Address - Phone:978-922-1344
Practice Address - Fax:978-922-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084000AMedicaid
MA110084000AMedicaid